Normalized as we sit here today, so check, that's behind us. What we still saw in the quarter was strong performance from a recurring revenue perspective. Recurring revenues were up 24%, and so we're pleased with the way that went, but again, a little softer start than we'd anticipated, all of that being behind us.
Great. What was the impact of the Change Healthcare cyber attack? Anything to call out?
Yeah, a couple of things we saw. So the Change Healthcare attack meant that some of our customers, hospital customers, weren't getting paid or had their payments held up, so we saw a small number of console deals get held up. Importantly, one of those deals has signed in April, so that seems to have normalized there. And then we saw some of our treatment revenues slow down in the waning weeks of March, and importantly, our April treatment sales have come back to where we expect. So again, check. We believe that that's also normalized now and is behind us.
Great. And I know that previously you had called out some other factors like competitive misinformation. It sounds like that's behind you as well. Capital budgets and staffing, it sounds like, you know, it is status quo at this point. And then you did mention, TabloCart availability. Out of these factors, there's anything else to call out that may still be a gating factor?
No. All of those, Shagun, are now behind us. You know, from a capital perspective, we have seen that environment stabilize. That's what we're looking for. So it's not getting any worse, which is great. And then importantly, what we as we think about the second half of the year, you know, we talked in three Q of last year about our sales cycles elongating a little bit. We will lap that sales cycle elongation here in three Q. And so again, that's one of the reasons why we have conviction in our second half guidance as we've laid out.
Understood. You know, just with respect to TabloCart, I wanted to get some clarification on the timing. I think you'd submitted it in August of last year, and you'd indicated a 9-to-10-month timeline, which would put you in the May-June timeframe. I know your guidance was for the back half of 2024, and there is a little bit of a ramp, you know, to really get the product out. Can you just walk us through that? Was the timing in line with your expectations? And then, you know, what is the ramp period before you can actually get things going? And is second half still the right way to think about, you know, the potential upside from here?
Yeah. So we had guided again to sort of second half coming back. 9-10 months puts you in that sort of call it June timeframe, and so our initial expectations was we'd get the approval kind of maybe end of June, for lack of a better word, and be starting to ramp in Q3 and fully ramped up exiting the third quarter. So we are a little bit ahead of that with the May approval, but again, it's only weeks ahead. You, you know what I mean? And so the activities now that we have to do, it's not really marketing activities, it's not really, what I'll call selling activities. Again, these are customers who know the product, who've expressed an interest in them, but because we were on hold, we could not sign order agreements or quotes or purchase...
or take purchase orders with the product. And so what we have to go do now, what we're focused on doing since last Monday's approval, is on working with customers to make sure they still have the budget earmarked for the product, getting the order agreements and purchase orders re-spun for the product, that sort of activity. Now, again, this is not... You know, we don't think it's gonna take a long, long time, but we do expect that. That is a focus for ours in the remainder of Q2, and we are working to make sure that we're set as we enter the back half, as we enter Q3, with kind of that ramping activity substantially behind us.
You know, one of the questions I had, and I know I've asked you this in the past, is that, you know, it was quite surprising to me how important TabloCart, you know, became in the grand scheme of things, which is probably a good thing going forward now. But, can you help us put that in context? Because initially, it was supposed to be a single-digit impact to sales, and then we did see those console delays. So, you know, how should we think about the importance of that product even going forward? I think there's a $10,000 additional ASP attached to it, so it could be an opportunity here.
Yeah, it is a $10,000 ASP. That is correct. With respect to the product, so we launched TabloCart in late Q3, early Q4 of 2022. So by the time we put the product on hold, we really only had 3 quarters of experience with it. And so, yes, it was single-digit $ million of revenue associated with the product, but what we learned is that we created something that customers really wanted and really valued. Importantly now, now that we have that approval, we're going back out there to sort of make sure that we capitalize on that demand, get ramped up, as we mentioned, in 2Q, to set ourselves up for 3Q and beyond.
You know, how should we think about the adoption of TabloCart? You know, what percentage of your, I guess, 4,000 acute install base do you expect it to be launched in? Or, will it be an add-on for newer installs? How should we think about adoption there?
Yeah. So it's available for both. So we do expect to go back and sell it into our install base. We also expect to make it available for new orders that we may, you know, that we may get. We haven't guided to the attach rate of the cart product, and honestly, it's only because that product is relatively new. Again, we only had 3 quarters of operating experience. But again, we were really pleased with the uptake of the product when we had it, and now that we have it back, we're excited to go in again and sell it into the install base and sell it as part of new quotes.
And what feedback are you getting on it? I know it was, you know, TabloCart with prefiltration, you know, typically where the water quality is not good, but what other feedback are you getting? You know, why is the demand so high for this?
Yeah, the cart does three things: so one is the pre-filtration, but two, it also raises the height of Tablo, so it's on bigger wheels. And so it literally raises the height of Tablo to a point where it's easier to push around in the acute setting, just from a height perspective. And number three, the wheels are bigger and more maneuverable. All four wheels turn on the cart than they do on Tablo. And so it's the combination of all or some of that that is really appealing to customers. It does a lot that customers really value.
Got it. And, you know, as we think about the first half, second half dynamic, and we think about, you know, the deferrals on the cap, on the console side for Tablo, you know, anything you can help to put this into context for us? I think if I look at first half versus second half, there's a $30 million delta. Is that the backlog?
So let me maybe contextualize how we thought about the second half. And so if you look at kind of our guidance, if you look at consensus, you can sort of see that there's, call it, $80 million, round numbers, of total revenue for the second half of the year. Again, in super round numbers. Of that, roughly 50% will be recurring revenues off our larger install base. The recurring revenues for us are consumables and service contracts, and they've been reliable, a reliable sort of base on which to grow quarter on quarter. So roughly 50% recurring revenues, levels we've seen before. That leaves roughly $40 million of implied console revenue for 2H 2024. That level of console revenue is the same thing we've already done in 1H 2023.
So in simple terms, what we're looking for from a console perspective to get into our guidance range for 2H is the same volume of console revenue we did in 1H of 2023. And then, as in any quarter or as in any period, we still, you know, as we move through the guidance range, it's more console in our two large end markets where the value proposition is proven. We can sell more cart into the install base. ASP has been a lever for us. Our Tablo Pro Plus has been a lever for us. So there's a lot of ways to move up through the guidance range. Does that make sense, Shruti?
Yep. You know, it sounds like, you know, there is a base case scenario that you've laid out for the back half. That is fair. You know, if we look at growth, there's a pretty substantial increase, like 16% in the first half versus 48%. It looks very heavily weighted, you know, on Q4. So, you know, I guess, you know, is that... And you're assuming similar consoles that you did, like you mentioned in the Q1, sorry, in the first half of 2023. So should we think of your guidance as conservative? And then within the range, where are you more confident should we be, at the upper end of the range for the full year?
We have a lot of conviction in our back half guidance range. You know, we are sitting here having just printed Q1, and our focus really is on Q2, delivering kind of the low $30 million guidance we talked about, and executing through this ramp of TabloCart that we talked about, right? To set ourselves up well for the back half. Now, other than sort of reiterating the range and how we think about that, I'd just leave you with our focus right now is on executing into that range.
Got it. Any other color on, April and possibly May trends to call out, including the capital funnel as you're going out and re-engaging? I know you just got approval, so-
Yeah.
But any color?
The big thing, so number one, we're re-engaging, as you mentioned. The big thing to call out is we saw the treatment volumes, the consumable volumes, come back to levels we'd expected. Again, suggesting that the Change Healthcare situation is behind us. But, you know, other than that, our focus now is on executing, as we talked about.
Got it. Nabeel, I'm hoping you can, you know, help us understand, longer term growth. You do have an LRP out, which is for high teens, annual sales growth from 2025, you know, through 2027. You know, just curious, how are you thinking about the assumptions behind that? Is that a base case scenario as well? And, and you didn't, recently reiterate the home mix. Previously, you'd said 25%. Just curious if that is still on track.
Yeah, let me address the second question first, 'cause it's sort of more near term. Yes, our home. Nothing has changed with respect to our home expectations. We expect home to continue to grow in a linear fashion between now and sort of through the end of our LRP period. That's number one, nothing has changed. Home is a large market opportunity. There's no reason that could not go better, but from a guidance perspective and an outlook perspective, yeah, nothing has changed. Now, with respect to how we thought about guidance for the long term, we placed roughly 1,400 consoles in 2022 and 2023. If we place the same number of consoles every year, then the recurring revenues on our growing install base will allow us to grow the top line by about mid-teens.
So flat console placements, roughly 1,400, gets us to roughly mid-teens growth. And then we have to place incremental consoles to get from the mid-teens to our guidance over the long run of high teens. And those console placements, number one, the two large end markets, acute and home, where there is clear value proposition in both. Number two, there continues to be sort of uptake or upsell, if you will, of our Tablo Pro Plus, of our TabloCart, now that it's back, which will continue to benefit ASP. And so that's how we thought about the guidance going forward, Shruti.
Is that a base case? How did you think about it? Or do you have, you know... Or is that a realistic target?
Well, so we're giving you the visibility and sort of outlining how we thought about it as best as we can. Now, again, there's no reason we cannot do better, but for right now, that is our guidance. That is our best expectation of what's going to happen.
Okay, fair enough. You know, I wanted to touch base on some of the positive progress you've made towards profitability. So on the Q1 call, you did announce an additional restructuring initiative. You're saving about $100 million in cost over the next couple of years. You're pulling forward your break-even point by at least a few quarters, and you have indicated you don't need to go to capital markets anymore. Can you elaborate on the areas of savings and also the timing? You know, why was this important to do now?
Yeah, so why was it important to do now is because as we entered this year, we wanted to clear the two big overhangs that were weighing on us, weighing on our stock, weighing on your minds, one of which was getting TabloCart approved, and the other one was solving our balance sheet, financing overhang, whatever you wanna call that, right? So that was kind of our impetus for why now. We wanted to make sure that we entered this year clear, if you will, of any of the overhangs that were weighing on us. That's why now. In terms of how we went about it, so we literally looked at everything. So the first thing is, we did is we stacked all of our people.
We looked at spans of control, layers of management, all of that stuff, and sort of where there were... You know, like in any company, as you grow, maybe you're promoting people, and their team sizes shrink, so maybe there's layers of management you can remove. You can sort of fix spans of control. That was part one. Part two, we looked at projects, and we looked at specific programs, and what we wanted to do was make sure we are funding programs that deliver ROI within our LRP period. We've always been an ambitious bunch, and we've always had programs that are sort of longer, duration, if you will. And so as we went through, we cut back on those programs. The little over half of our cuts, if you will, are in R&D and operations areas, the other half are everywhere else.
And so sort of once you trim the programs, once you trim the layers of management, fix the spans, then there's also overhead roles that come out of the organization, CapEx comes down, all of that. So that's kind of how. And from a magnitude perspective, we said $20 million will come out of this year, excuse me, and that'll grow to $30 million next year and grow a little bit in 2026 and 2027. So it's a little over $100 million. And then I'll just wrap on this part by saying, you know, if we do a little bit better on gross margin, which we've done well on, sort of for the 12 preceding quarters, that could add to the savings we potentially get out. So again, it's a little over $100 million with the potential for a bit more.
In terms of the break-even point, I know you said a few quarters. You know, correct me if I'm wrong, I think previously you'd said exiting 2027-
Correct.
-potentially. So, so where does that put you? Like, early in 2027, or, like, should we assume full year profitability in 2028? Just if you can put the timeline a little bit more into context for us.
Yeah, I did say a few quarters ahead. Yeah, mid-2027, you're sort of in the zone of that a few quarters ahead. Yeah.
Okay, got it. And then, you know, also, you know, just elaborating on your profitability goals with respect to margins. You know, gross margins has been an area of success for you. You know, I think it's probably the same three drivers that you've talked about, but, you know, how should we think about, you know, the progression from Q1 to Q4, and then from here to 2027?
Q1 to Q4, so we printed 31%, 31.1% this year, non-GAAP gross margins, and our guidance is mid-30% exiting Q4 or in Q4, exiting this year. It'll be a linear ramp-up from here. And it's... If you look back at our track record, it's mostly been a linear ramp, from a gross margin perspective, so that's what'll happen between now and Q4. And then propelling to the 50% next milestone in tw- exiting 2027, it will again be a linear ramp, so we would expect to sort of take that same curve and draw it out forward. The drivers are the same, but one thing I'd say is sort of, we get margin lift just from the mix shift associated with our growing install base. As the install base grows, we sell more consumables. Those consumables have a higher margin.
We sell more service contracts. Service contracts have a higher margin because, you know, you know, we don't have to add people at the same rate. There's natural leverage built in. And then we also have our console cost down program, which we've had since we had consoles, which is where R&D and supply chain strategies are employed to take costs out of components in the console. So same three drivers, same three drivers, and continued linear path to 50% as the next milestone.
I guess a couple of follow-ups. You know, with respect to volume growth, console cost downs, and consumable pull-through and service leverage, which of the area has driven the outperformance? And now, as we think about, you know, your console sales continuing to ramp up, especially in the back half, will there be some pressure, or you're still saying, you know, expect it to be linear despite that?
Expect it to be linear, despite that. If you look back, you know, going back to sort of 2020, 2021, the console cost down played a bigger role. As we have moved beyond 2021 to 2022, 2023, now you're starting to see more balanced contribution. Console cost down plays a role. You're starting to see more pick-up from consumable pull-through, and as we move forward in time, you'll see more of just the consumable pull-through being a driver, a bigger driver of the margin, expansion story, as well as the service leverage compared to console cost down. And that's just because the install base is larger and the mix, you know, shifts more.
Got it.
Yeah.
And then with respect to capital and consumables, can you, can you parse that out for us and tell you where do you stand right now? And as you hit that +50% mark, you know, where do you expect, you know, the-
Yeah
margins to be, and what are peak margins for capital and the consumables?
Yeah. So the capital today is sort of low double-digit, so sort of low double-digit gross margins. That'll grow to between 20%-40% as we get to 50% gross margins. The reason for the range is because home consoles have a lower ASP. Acute consoles carry a higher ASP. It's the same box, it's just the ASP difference. So that's on the capital side. On the consumables, they're today roughly 50%. That'll expand. Our consumable is the plastic and tubing, and so again, as we build more, the component costs or the raw materials costs come down, so we expect that to expand as well. But it's already 50% today, it will go higher.
So on the consumable side, what would potential peak margins be? And also on the capital side.
Yeah. Oh, sorry, sorry, I didn't answer that. Yeah, so peak margins, you know, they will be higher. Again, our focus right now is to get to the 50%, and so again, that's, that's the guidance that we're talking about. If you think about margins beyond 50%, just the incremental placement of consumables, meaning the pull-through on a larger install base, that will drive... That alone will drive the margin above the 50% into sort of 52%-55% zone, without incremental cost down on the console, without any of that, which we'll-- which we plan to continue to do. So again, there's no reason why we can't deliver margins well north of 50%, but right now, our focus is on getting to that mile marker.
Understood. I wanted to talk about drivers of the acute and home setting. I guess with respect to acute, on the Q1 call, you called out that, you know, you have more than 60% of your acute pipeline consist of deals that are greater than $1 million, and more than 50%, you know, represent new potential customers. Can you walk us through, you know, some of the metrics on your acute side? You know, how has that changed over the past couple of years?
Yeah. So our focus... I'll take you back in time a little bit. Our focus going back to 2020, 2021, was to land signed agreements, initial agreements with all the big nationals, the big eight nationals. And then at the time, we said a third of the top 100 regionals. So we did that. We've obviously signed additional regional logos since then. And then our next focus was to, number one, make sure that we were able to do expansions, to actually pull through expansions, and then, as we were doing expansions, to increase the size of our deals, right? Instead of doing smaller deals, we wanted to go in and do whole house conversions.
So as we sit here today, what we're really pleased with is, as we see 60% of the pipeline being deals of over $1 million, that suggests that our strategy to be doing these larger and larger deals is paying off, so that's great. Check. And then number two, we wanted to make sure that while we are doing expansions, we are still able to pull through new logos, which having 50% of our pipeline be new logos, suggests that now we're balanced between land and expand, which is also positive as we move forward.
That's really helpful color. With respect to penetration, are you still somewhere around high single digit, low double digit, or where do you stand?
Yeah, so we print our installed base. We printed our installed base exiting Q4, 4,050 consoles in the acute. We think the TAM within the acute setting, and we include sub-acute in there, it's hospitals and sub-acute, we think the TAM of 40,000 consoles. So yeah, we're sort of 10% penetrated in that zone. Yeah.
Got it. With respect to your home strategy, you know, can you just walk us through, I guess, why do you have so much success with the MDOs? I guess the big question is really the shift to the home setting. You know, it's about 12%, still a big portion is PD. You know, where do you see it trending? Is the ETC program having any impact?
Yeah. So with respect to the MDOs, your first question, why are we having success with the MDOs? We believe, and US Renal is an example, we just did a press release with them about a deal that they had signed. Really, what the MDOs are seeing is, with Tablo, they can, number one, they can add patients to their census and get revenue for reimbursements associated with those patients without adding to the fixed cost base. They don't have to build additional clinics. That's number one. Number two, Tablo's very strong retention rates. We talked about 90% retention after 90 days, which is 40% better than the predecessor device. We've talked about sort of, 10% voluntary or, controllable attrition, I should say, 10% controllable attrition at a year, which is again, markedly better than the predecessor device.
Tablo's strong retention rates allow the provider to sort of make money for longer, keep the patient at home longer, and avoid the patient from having to crash back into the hospital. So that's sort of, we think, driving the home. What were the other parts of the question, Shagun, sorry?
I was just wondering, you know, I guess the MDO question and the 12% penetration in the home setting.
Yes.
You know, where does that go over time, and if ETC is having any impact?
Yes, ETC. So the richer the ETC is, the ESRD Treatment Choices model. This basically allows for higher payments to providers who send more patients at home, and lower payments if you don't send enough patients at home. The richer parts of the ETC are in 2025, 2026, and 2027, so that's still coming. So yes, that could absolutely be a tailwind. That could absolutely be a tailwind for us.
And in terms of the penetration, so we believe PD, PD is the dominant at home right now, but we... And we talked about this on our call, we think there's a really strong pathway for PD patients to stay home with HHD, with home hemodialysis, with our products, where today, PD patients who come, where the therapy fails them, they come back into a clinic. We think we keep them home. So we view that as also another tailwind for us.
Got it. I guess last question for me. Nabeel, the stock is up pretty substantially this quarter. It's still down for the year, but I think a lot of investors are looking at it and, and seeing what the back half looks like. You know, from your standpoint, you know, what is still underappreciated, and where do you see room for upside? Or any closing remarks you might have.
Yeah. Thanks, Shagun. So four things. Number one, we have achieved scale in the acute with 4,000 consoles in the acute setting. Number two, that scale really drives a very strong recurring revenue foundation for our business. Half of our revenues, again, for the second half and for any period, are recurring revenues, which is great. Number three, we have lifted the two overhangs on this. We've gotten clearance of TabloCart with prefiltration, and we've sort of solved the balance sheet and the financing overhang. And so what we're really focused on now is executing in 2Q, setting ourselves up for that strong back half, getting through 2024, and setting up for the long run.
Great. Thank you so much.
Thank you.
Good luck, Nabeel, and thank you for being here.
Thanks, Shagun.